Complete NCLEX PREP Flashcards

Question

#2 Problem with Alcoholism/Abuse

Answer 1

Dependency vs Codependency

Answer 2

Abuser gets significant other to do things for them or make decisions for them. The abuser is dependent on others

Answer 3

Significant other derives positive self-esteem from making decisions for or doing things for the abuser. The abuser gets a life without responsibility while the significant other gets positive self esteem ex: They'll say, "Aren't I a wonderful spouse bc I did this for you."

Answer 4

1. set limits and enforce them. Teach significant other to say NO. 2. Work on self-esteem of the codependent person to solve the issue. " Im saying no and im a good person bc im saying no" 3. May solve the problem but may lose the relationship

Answer 5

Manipulation: abuser gets significant other to do something that is not in the best interest of the significant other. Nature of act is dangerous or harmful.

Answer 6

In both situations, the abuser is getting them to do something for them. The difference is neutral vs negative. Look at what they're being asked to do. ex: a 49 y/o alcoholic gets her 17 y/o daughter to go to the store and buy alcohol for her (this is illegal bc she's underage and puts her at risk)

Answer 7

1. Set Limits and enforce them. You say NO. Easier to tx bc nobody likes being manipulated. No positive self-esteem issue with manipulation like there is withe codependency/dependency

Answer 8

Wernicke: encephalopathy Korsakoff: psychosis psychosis induced by vitamin B1/thiamine deficiency caused by alcoholism

Answer 9

-lose touch with reality; psychotic -amnesia with confabulation (memory loss, making up stories) bc they forgot and they really believe it * memory loss is what happened in the 1990s? not a person got drunk last night and forgot what happened

Answer 10

- do not present reality bc they won't learn it -REDIRECT--> rechannel it into something they can do. DO NOT tell they what they can't do.

Answer 11

-Preventable: take vitamin b1 which is a coenzyme needed for metabolism of alcohol; if deficient, alcohol will be stored and ruin brain cells -Arrestable: they don't have to stop drinking, they just have to take vitamin B1 -stop from getting worse -Irreversible: 70% irreversible

Answer 12

-Aversion Therapy Aversion: really strong hatred for something -works in theory better than in real life -Onset and Duration: 2 weeks before effectiveness and 2 weeks off drug until they can drink again

Answer 13

-avoid all forms of alcohol to avoid n/v, death including: mouthwash, aftershaves, perfumes/colognes, any OTC that ends in -elixir, alcohol based hand sanitizers, uncooked icings bc they have vanilla extract, they CAN have red

Answer 14

upper, downer

Answer 15

1. caffeine 2. cocaine 3. PCP/LSD 4. Methamphetamines 5. Adderall (Add drug)

Answer 16

-euphoria, tachycardia, tachypnea, restlessness, HTN, Irritability, Diarrhea, Borborygmi, 3+/4+ reflexes, spastic, seizures

Answer 17

Everything that's not an UPPER so only memorize uppers

Answer 18

-make things go down; decreased -respiratory arrest is the biggest risk -opposite of uppers symptoms

Answer 19

Not B, bc its not a downer, Its an UPPEr! Do not just use ABCs

Answer 20

is the question talking about overdose or withdrawal? Overdose/Intoxication: you have too much Withdrawal: You don't have enough

Answer 21

everything going UP so pick the UP things

Answer 22

everything going DOWN so pick the DOWN things

Answer 23

not having enough downers, so pick the UP things

Answer 24

now having enough upper, so pick the DOWN things

Answer 25

1. downer withdrawal 2. upper withdrawal

Answer 26

downer overdose upper withdrawal

Answer 27

upper overdose downer withdrawal

Answer 28

1. Irritability 2. 4+ reflexes 5. Borborygmi 6. Increased Temp THOUGHT PROCESS: -Pt on upper drug -overdosed on upper, therefore too much upper -this is a CNS drug not an AUTONOMIC

Answer 29

intoxication, withdrawal within 24 hours = intoxication after 24 hours = withdrawal

Answer 30

1. Difficult to Console 3. Exaggerated Startle Reflex 5. Seizure Risk 6. Shrill high-pitched cry THOUGHT PROCESS: -downer drug -withdrawal of downer since its 24 hours -too much UPPER

Answer 31

No -AWS always comes first within 24 hours after they stop drinking; not life threatening; pts not danger to self or others -DT MIGHT occur 72 hours after (under 20% chance of happening); CAN kill you; pts dangerous to self and others

Answer 32

1. Regular diet 2. Semi-private anywhere on unit 3. Up ad lib./ Go around anywhere they want to go 4. No restraints (not a danger) 5. Meds: -antihypertensives (everything going up due to withdrawal of downer) -tranquilizer -multivitamin containing Vitamin B1 to prevent Wernicke Korsakoff

Answer 33

1. NPO or clear liquids - risk of seizure due to withdrawal of downer --> UPPER S/S 2. Private room near nurses station b/c dangerous and unstable. Usually on step down unit 3. Strict bed rest. No washroom privileges 4. Restraints: Vest or 2 point locked leathers (opposite arm and opposite leg) rotate q2h. Lock Leg first then the Arm, then release 5. Meds: -antihypertensives (everything going up due to withdrawal of downer) -tranquilizer -multivitamin containing Vitamin B1 to prevent Wernicke Korsakoff

Answer 34

Powerful class of antibiotics they are antibiotics used to tx a mean old infection that is resistant, serious, life threatening, resistant, gram negative

Answer 35

1. N 2. Y 3. N 4. N 5. Y 6. Y 7. Y 8. N 9. N

Answer 36

-MYCIN Think A MEAN OLD MYCIN

Answer 37

not an amino glycoside and can be used for regular type infections ex: Arithromycin, Zithromycin, Claithromycin

Answer 38

1.Think MICE---> Think EARS-----> OTOTOXICITY -hearing, ringing/tinnitus, vertigo (equilibrium), dizziness (equilibrium) 2. Human ear is shaped like a kidney ---> NEPHROTOXICITY -creatinine is THE best indicator of kidney function (don't go for U/O, BUN) -24 hr creatinine clearance is BETTER than serum creatinine -Serum Creatinine comes next over anything else 3. Think number 8 drawn inside the EAR -toxic to cranial Number 8 (ear nerve) -administer them q8h

Answer 39

IM or IV Do not give PO bc they are not absorbed except in: 1. Hepatic Encephalopathy -oral mean old mycins will go in your gut and kill gram negative bacteria which produces ammonia -this will help get rid of high ammonia levels -at the same time, the drug will NOT of to the liver (since its not absorbed) which is good in liver failure 2. Preop Bowel Surgery -cleans the gut out No toxicity or Nephrotoxicity bc no absorbed

Answer 40

Oral Bowel sterilizers Neomycin and Canomycin are top 2. Who can Sterilize my bowel? NEO CAN

Answer 41

TROUGH: drug at its lowest ADMINISTER PEAK: Drug at its highest

Answer 42

-narrow therapeutic window -small difference bw what works and what kills -draw TAPS ex: DIGOXIN lowest: 0.125 largest: 0.25 Therefore, narrow range so TAP needs to be drawn

Answer 43

SL--> TROUGH: 30min before next dose PEAK: 5-10 min after drug dissolved IV--> TROUGH: 30min before next dose PEAK: 15-30 min after drug is finished, not when you hang it ex: 100 ml at 200 ml/hr. It will be finished in 30 mins. You hang it at 1000 and it finishes at 1030; draw peak from 1045-1100. If you get 2 correct values in range, choose the on that is the highest w/o going over IM--> TROUGH: 30min before next dose PEAK: 30-60min after injected. Choose 60 min if both options given Subs--> TROUGH: 30min before next dose PEAK: See diabetes lecture. Only Subq they talk about are insulins PO--> TROUGH: 30min before next dose PEAK: Forget about it bc they don't test it. TOO variable

Answer 44

-Like Valium for your heart (calms it down); Negative Inotropic

Answer 45

1. Y 2. N 3. N 4. Y 5. Y

Answer 46

cardiac stimulants strengthen, speed up, make it work harder

Answer 47

cardiac depressant slow down and depress the heart

Answer 48

AAA! Antihypertensives: they relax your heart and blood vessels Antianginals: Relax the heart so it uses less O2, decreasing oxygen demand Anti atrial-arryhtmias: only atrial arrhythmias. NOT ventricular. tx A flutter, A Fib, Paroxysmal A tachycardia (anything atrial)

Answer 49

Yes bc SUPRA means above, therefore SVT means ABOVE THE VENTRICLES = Atrial

Answer 50

Hypotension: Vasodilation Headaches: vasodilation in the brain (usually always in SATA) Always measure BP due to risk for hypotension Parameters: Hold CCB if Systolic is <100 mmHg

Answer 51

-dipine (not -pine) -Verapamil Cardizem (can be given continuous IV; IF SBP <90, slow and titrate the drip to keep SBP >100)

Answer 52

Normal Sinus Rhythm -There is a P wave before every QRS, which is followed by a T wave -Peaks of P waves are equally distant from one another so its not a SINUS arrhythmia

Answer 53

V FIB -chaotic squiggly line -is there a pattern? NO

Answer 54

V Tach -Tombstones -sharp peaks and jags -is there a pattern? YES -Bizarre=tachycardia

Answer 55

Aystole -no QRS

Answer 56

Ventricular

Answer 57

A flutter -saw tooth

Answer 58

A fib -Like jello -chaotic= fibrillation

Answer 59

periodic widened QRS Low Priority Unless: -more than 6 PVCs in a minute -more than 6 PVCs in a row -if the PVC falls on the T wave of the previous beat if 1/3 are true, you elevate priority of PVC client to moderate (never high priority level)

Answer 60

Asystole and V Fib -Kill you in 8 minutes or Less/ High Priority!

Answer 61

V Tach -there is Cardiac output if there is a pulse

Answer 62

amiodarone or lidocaine

Answer 63

ABCD 1. Adenosine -fast IV push: <8 sec -can go into systole for 30 sec due to fast push but should come back 2. Beta blockers (-lol) -Neg inotrope: Valium for your heart -Tx AAA and AA -Therefore Side effects--> hypotension and headache just like CCB 3. CCBs (same as beta blockers) 4. Digitalis -Digoxin -Lanoxin

Answer 64

for VFIB, You DFIB shock them!

Answer 65

Epinephrine and Atropine in that order

Answer 66

Re-establishes Negative pressure in pleural space so that the lung expand when the chest wall moves -Negative pressure is good in pleural space= makes things stick tiger (visceral and parietal layer) -positive pressure pulls things apart= more work; less air, bc of positive presuure

Answer 67

Pneumothorax= remove air hemothorax= remove blood pneumo-hemo thorax= removes air and blood

Answer 68

c bc its not doing what its supposed to do

Answer 69

its not supposed to drain

Answer 70

A for A and B for B Apical: chest tube is way up high---> draining air bc air rises (pneumo) Basilar: chest tube is at the bottom of the ling ---> draining blood bc it is subject to gravity (hemo)

Answer 71

1. BAD! 2. GOOD!

Answer 72

1. TWO. Apical fro pneumo. Basilar for hemo 2. TWO. Both Apical 3. TWO. Apical and basil on side of sx 4. Removal of Lung so NONE (CT only for lobectomy, wedge resections, etc.)

Answer 73

1.) If you knock it over, set it back up and pt needs to take deep breath (not a medical emergency 2.) If device breaks, positive pressure can get into pleural space a. CLAMP so nothing gets in b. CUT the tube away from the broken device c. SUBMERGE end of tube into sterile water d. UNCLAMP it b/c re-established water seal (thats the order alphabetical) NOTE: best question is different than the first question a. BEST= SUBMERGE b. FIRST= CLAMP 3.) IF CT gets Pulled Out a. FIRST: take a gloved hand and cover the hole b. BEST= Cover in vaseline gauze 4.) BUBBLING (sometimes good sometimes bad) a. INTERMITTENT WATERSEAL= always good, document it b. CONTINUOUS WATER SEAL= there is a leak, this is bad. Find it and tape it until it stops leaking c. INTERMITTENT SUCTION CONTROL CHAMBER= bad, this is not high enough. Suction is too low. Go to the wall and turn it up until continuous bubbling d. 2 GOOD AND 2 BAD SCENARIOS i. just remember one situation, and the other is the opposite. ii. continuous bubbling in water seal is like a bottle of pop. If it was continuously bubbling, would you buy it? NO. There's a leak just like a CT

Answer 74

-Never clamp CT for >15 seconds without a doctors order -Use rubber tipped double clamps (rubber tipped to prevent puncture of tube)

Answer 75

Every on is either trouble or no trouble (there is no in between) Memorize TRouBLe -There are 47 heart defects. -all of them that start with T are Trouble

Answer 76

1. no trouble 2. trouble 3. no trouble 4. trouble 5. trouble

Answer 77

teach about implications, not diagnosis

Answer 78

"VarieD PictureS Of A RancH 1. VD: ventricular defect 2. PS: pulmonary stenosis 3. OA: overriding aorta 4. RH: right hypertrophy (don't memorize what they are just memorize the names)

Answer 79

-Private room preferred or cohort of same disease that are (+) through culture -gloves, gowns, hand washing, no mask, dedicated equipment 1.ANYTHING ENTERIC (caught from intestine fecal-oral) -CDIFF -Hep A (anus) -Cholera 2.Staph Infection 3.RSV -transmitted through droplet But is on CONTACT precautions bc with little kids they get it through contact of contaminated objects 4. Herpes 5. Shingles (herpes zoster)

Answer 80

-Private room preferred or cohort of same disease that are (+) through culture -mask, gloves, hand washing, dedicated equipment - Bugs that travel 3 feet -Meningitis -H flu which causes epiglottis

Answer 81

-private room REQUIRED unless cohorting -mask, gloves, hand washing, special filter mask for TB, patient mask needed, negative airflow -Measles -Mumps -Rubella -TB (spread by droplet, but airborne precaution) -Varicella chicken pox

Answer 82

DONNING -always take it off in alphabetical order 1. Gloves 2. Goggles 3. Gown 4. Mask DOFFING -always put on in reverse alphabetical for G's and MASK is second 1. Gown 2. Mask 3. Goggles 4. Gloves

Answer 83

a) dosage calculations b) IV drip rates: Formula= vol x drop factor/time in min c) Pediatric Dose questions: -2.2 lbs per 1 kg -amount per day vs amount to be given at one time d) IV Replacement questions

Answer 84

1. 2-3 finger widths below the anterior axillary fold to a point lateral to and slightly in front of the foot - you don't measure any landmark on the foot and NOT on the axillae. Rule these out! 2. when the handgrips are properly placed, the angle of elbow flexion is about 30 degrees

Answer 85

TWO POINT: -you move a crutch and the opposite foot together followed by the other foot and crutch -2 together at every time THREE POINT: -you move 2 crutches and bad leg together -3 things move together at every time -3 together then 1 FOUR POINT: -you move everything separately -you have 2 legs and 2 crutches -you move any crutch, but once you move that, your sequence is LOCKED IN -you then move the opposite foot followed by the other crutch followed by the other foot -very slow but stable SWING THROUGH -non weight bearing (amputations) -you plant the crutches then you swing through -you never put the leg down

Answer 86

-even for even, odd for odd -use the even numbered gaits (2 and 4) when the weakness is evenly distributed -Use the odd numbered gait (3) when one leg is odd -If they can't bear weight/amputation for instance, use swing through

Answer 87

1. 2 bc systemic disease 2. Swing through 3. Three point 4. Four Point 5. Swing Through 6. Four Point 7. Two Point

Answer 88

"up with the good, down with the bad" upstairs: lead with good foot then crutches go second downstairs: lead with the bad foot then crutches go second -crutches always move with bad leg

Answer 89

Always hold on opposite side of bad leg (good leg side, but advance it with the bad leg)

Answer 90

-pick them up, set it down, walk to it -if they need to tie their belongings to it, tie to side not at the front --> tip the walker over -boards does not like wheels on walkers or tennis balls on walkers

Answer 91

To determine the treatment, goals, meds, prognosis, LOS, legalities, etc

Answer 92

insight and is reality based. They are emotionally ill but NOT psychotic Insight: they know what's wrong with them and how its messing up their life Reality bases: they're senses make sense

Answer 93

Good Therapeutic Communication: -talk about how they feel -it is the RIGHT answer that would be RIGHT for every other type of patient who is not psychotic -tell me more.. -that must be very difficult... -how are you feeling right now? -what do you mean by? -etc

Answer 94

no insight and is not reality based Insight: They don't know they are sick. They may be able to state the disease but they don't know how it is affecting their life NOT reality based

Answer 95

uniqe specific strategies are needed good therapeutic skills do not work with these patients

Answer 96

Delusions: False fixed belief that or idea. There is no sensory component. With a delusion youre not hearing/tasting/seeing anything. Youre ONLY thinking it. Its just a thought Hallucinations: False fixed sensory idea or belief. You hear/feel/taste/smell/touch these things Illusion: Misinterpretation of reality. It is a sensory experience

Answer 97

1. Paranoid delusion: False fixed belief that people are out to harm you. -ex: The police/mafia/wife/kids lying/stealing/etc. 2. Grandiose delusion: You think you are superior. -ex: Christ/ghandi/smartest/etc 3. Somatic delusion: False fixed belief about a body part. -ex: I have x-ray vision, I can melt stones with my eyes, my brain is a martian super conducting proton accelerator. There are worms inside my arm. Pregnant 83y/o male.

Answer 98

Five types of hallucinations; one for each sense. Most common is AUDITORY. -voices telling you to hurt yourself. Next most common is VISUAL Third most common is TACTILE. Last two are GUSTATORY (taste) and OLFACTORY (smell) are relatively rare.

Answer 99

With an illusion there is a referent in reality. -Referent: Something to which a person refers to when they say something -There’s actually something there, they just misinterpret what it is With a hallucination, there’s absolutely nothing there.

Answer 100

1. This is an example of an auditory hallucination because there was nothing there. 2. This is an example of an illusion because they were talking, but it was not demons. 3. Hallucination. 4. Illusion. Because there is a referent, yes it was the fire extinguisher.

Answer 101

1. FUNCTIONAL PSYCHOSIS: They can function in every day life. They can have a marriage, family, job, etc. NO brain damage, just chemical imbalance & ineffective coping. a. Four diseases that fall under 90% this “schizo, schizo, major, manic” i. Schizoprenia ii. Schizo-affective disorder iii. Major depression (different from depression) iv. Manic - 2. PSYCHOSIS OF DEMENTIA: Actual brain damage occurs à psychosis a. Alzheimers b. Stroke c. Organic brain syndrome d. “senile” e. “dementia” 3. PSYCHOTIC DELIRIUM -TEMPORARY, sudden, dramatic, secondary, loss of reality. Usually due to some chemical imbalance in the body.

Answer 102

yes. No. Only in acute phases.

Answer 103

No brain damage Therefore, potential to learn reality Nurse: Teach reality by the use of the four step process! 1. Acknowledge feeling. - Usually the word “FEEL” is in the answer - Or you can specify a feeling for instance - I see you’re _____ - This must be very distressing for you 2. Present reality. - I know that ____ is real to you but I do not ______ - Tell them what is reality, “I am a nurse, this is a hospital, etc.” 3. Set a limit. - This topic is off limit - We are not talking about this - Stop talking about those ______ - We’re not going to talk about those voices - You can be this directive/strong! 4. Enforce the limit. - I see you’re too ill to stay reality based so our conversation is over - Ending the conversation - Not taking away a privilege à punishment - Bad answers construed as punishment. (“Since you can’t follow the rules, you lose your telephone privileges, etc”)The only enforcement is ending the conversation! Would you like some medication to help you with this symptom? a. Show them that this is not them it is their illness b. They can take medication to deal with symptoms and be compliant with medications!

Answer 104

Structural brain damage Cannot learn reality Two step process 1. Acknowledge their feelings. 2. Redirect them. - Channel them to do something they can do instead of what they can’t do. 3. DO NOT PRESENT REALITY. *** - Don’t confuse this with reality orientation à which is ax their orientation and telling them person, place, time. This is ALWAYS appropriate. 4. DO NOT SET LIMITS.

Answer 105

‣drug reaction can cause patients to lose touch with reality ‣People that are high on uppers ‣Withdrawing from downer (DT would be this) ‣ Post op psychosis especially in OA ‣ICU psychosis due to sensory deprivation ‣UTI in OA ‣Thyroid storm ‣Adrenal crisis

Answer 106

-remove underlying cause -keep them safe 1. Acknowledge Feelings 2. Reassure 3. Do not Present Reality 4. Do not redirect them bc it won't work

Answer 107

1. Schizo affective so FUNCTIONAL psychotic. - I see that you are frightened. -Those people are not planning to kill you, we are all safe. -Furthermore, we are not going to discuss this. -If they keep talking about this, I see you’re too ill to have a conversation right now. 2. DEMENTIA psychotic. -I see that you are frightened. - Why don’t we go somewhere where you can feel safe. 3.Delirium tremons à DELIRIUM psychotic. -I see that you are frightened. -This is temporary, you are safe here. This feeling will go away when you get better.

Answer 108

Functional Psychotics -use good therapeutic communication

Answer 109

Your thoughts all over the map 1. Flight of Ideas 2. Word Salad 3. Neologism 4. Narrowed Self Concept 5. Ideas of Reference

Answer 110

You go from thought to thought to thought. You say phrases that are coherent but the phrases are not tightly connected. Each phase by itself is coherent but together they are not.

Answer 111

They cannot make a phrase that is coherent. They just babble random

Answer 112

Making up imaginary words. You’re a blinsabik. You’re a slaboshnizak.

Answer 113

When a psychotic refuses to leave their room or change their clothes. It is a functional psychotic. The reason why they are doing it is because the way they define who they are is very narrow à based on two things à where they are what they are wearing. a. Do not make a functional psychotic get dressed à panic b. Use four step process c. If not a psychotic , Use therapeutic communication skills and be directive! Just like if you were dealing with a post-op d. The only time you’re allowed to make decisions for patients are for those who are depressed but are not psychotic

Answer 114

When they think people are always talking about them.

Answer 115

cannot metabolize glucose which leads to cell death bc glucose is needed for energy

Answer 116

is a total different disease; not a type of diabetes mellitus ‣Diabetes Insipidus is polyuria, polydipsia → dehydration due to low ADH ‣It is like diabetes mellitus with the fluid part but not the glucose part ‣Do they have a low urine output or a high urine output? HIGH just like diabetes mellitus

Answer 117

‣SIADH is the opposite of DM and DI (polyuria and polydipsia) ‣s/s: oliguria; not thirsty because they are retaining water

Answer 118

‣High urine output = Low urine specific gravity ‣Low urine output = High urine specific gravity ‣Inverse relationship

Answer 119

1. high UO, Low urine specific gravity 2. High UO, low urine specific gravity 3. low UO, high urine specific gracity 4. DM, DI 5. SIADH

Answer 120

Three names: ‣ Insulin Dependent, ‣ Juvenile Onset, ‣Ketosis Prone ‣Juvenile onset = not used

Answer 121

Opposite names: ‣Non Insulin Dependent ‣Adult Onset ‣Non Ketosis Prone ‣Adult Onset not used anymore

Answer 122

Three P’s : ‣Polyuria: Increased urine output ‣Polydipsia: Increased thirst ‣Polyphagia: Increased swallowing ∙ Does not mean eating a lot ∙ It can be a symptom after a thyroidectomy!!! ∙ It’s only means eating a lot in diabetes. In every other context = swallowing.

Answer 123

If you don’t treat DM1 they could D.I.E. ‣Diet (least important of the three ) ‣Insulin*** ( most important tx modality) ‣Exercise

Answer 124

if you don't tx this, they could D.O.A ‣Diet (most important of the three) ‣Oral hypoglycemic ‣Activity Diet more focus for DM2, need calorie restriction, 6 small feedings per day (help keep blood sugar leveled→don't have big peaks→more normoglycemic)

Answer 125

“BEST” means you’re only choosing ONE. Therefore, think it through. If you choose a, you will most likely eat three meals following their calorie restriction. If you choose b, you will split into 6 feedings, but they can eat as many calories as they want. Therefore, choose A.

Answer 126

‣Humulin R, Novolin R, anything with R. ‣Onset: 1 hr ‣Peak: 2 hr ‣Duration: 4 hr ‣It is clear in the bottle so it’s a solution so it can be IV dripped ‣Short rapid acting insulin (it was made before lispro that’s why it’s classified as short rapid acting) ‣R sounds for Rapid and Run.

Answer 127

‣Onset: 6 hr ‣Peak: 8-10 hr ‣ Duration: 12 hr ‣True intermediate acting insulin ‣Cloudy →Suspension (not solution) ∙Suspensions precipitates→ particles fall to the bottom Therefore, NO IV drip →OD and brain death ‣N stands for Not so fast (Intermediate) and Not in the bag. 1, 2, 4, 6, 8, 10, 12 ‣124 = regular ‣681012 = NPH They test the PEAKS! 2 and 8-10.

Answer 128

‣Onset: 15 mins ‣Peak: 30 mins ‣Duration: 3 hrs ‣15, 30, 3. ‣Give as they begin to eat; give WITH meals Not ac meals

Answer 129

Onset: Peak: none. Duration: 12-24 hours ‣So slowly absorbed it has no essential peak ‣This one has low risk for hypoglycaemia (little to no risk) ‣Only insulin you can safely give at bedtime

Answer 130

‣Opening it. The minute you open a vile, the expiration date is not valid. ‣The new expiration date is 30 days after that! Make sure you write the date with EXP or OPENED then the date.

Answer 131

Refrigeration is optional. You don’t have to refrigerate in the hospital but at home, the patient does. In the hospital →unopened viles should be refrigerated. When you open the vile, it now does not have to be refrigerated.

Answer 132

‣exercise potentiates insulin (think of it as another shot of insulin) ∙bring a rapid metabolizing carb snack Sick days: ‣when sick, glucose goes up ‣take insulin even though theyre not eating ‣stress causes this ‣take sips of water to ↓ dehydration ‣stay as active as possible

Answer 133

1. Low Blood Glucose →insulin shock, hypoglycemic, or hypoglycemic shock 2.DKA 3. HHNK, HHS, HHNS

Answer 134

Causes: ‣not enough food ‣too much insulin (Primary Cause) ‣too much exercise ∙Danger: brain damage S/S: "DRUNK IN SHOCK" ‣DRUNK: Staggering gait, Slurred speech, Poor judgement, Slow reaction time, Labile emotions (all over the place), ↓ Social inhibation (loud, obnoxious) ‣SHOCK: Hypotension, Tachycardia, Tachypnea, Skin is cool and clammy, Pally, Mottle extremities Tx: ‣Rapidly metabolized carbs (sugar) ∙any Juice, Soda, Candy, Milk, Honey, Icing, Jam ‣Sugar+Starch OR protein (ideal snack) ∙crackers ∙slice of turkey ∙milk is sugar and protein (but you use SKIM milk so you dont break down the fat→ketones) ‣If unconscious →Glucagon IM, Dextrose IV (D10 ir D50) ∙the setting determines the route

Answer 135

‣only type 1 bc another name is ketosis prone CAUSES: ‣too much food, not enough meds, not enough exercise ‣#1 cause: acute viral upper respiratory infections within the last 2 weeks ∙viral pharyngitis→they recover w/in 3-5 days but after they recover intially, they start going down hill → lethargic → therefore, ASK IF THEY HAVE HAD AN INFECTION→ the stress of the illness was not shut off →fats were burned for fuel S/S: "DKA" ‣Dehydration ∙dry, poor skin elasticity, warm skin (water in body is the same as water in car meaning it is a coolant), HA, flushed, tachycardia ‣K is for: ∙ketones in blood (confirms diagnosis) ∙just bc you have ketone in urine doesnt necessarily mean you have DKA ∙Kussmaul Respirations (deep and rapid) ∙K+ High ‣A is for: ∙acidotic (metabolic acidosis) ∙acetone breath (fruity odor) ∙anorexia due to nausea (they dont want to eat) TREATMENT: ‣Fast IV fluids ∙IV w/ regular insulat at around 200ml/hr ∙main solution doesnt matter even if it has D5W (bc 1L only has 300 cal in it) ∙D5W does not even stay in the vein →it will not creater hyperglycemia unlike D10 or D50

Answer 136

"NON Ketonic"→ DM2 "DKA without the K and A" ‣Dehydration ∙dry, poor skin elasticity, warm skin (water in body is the same as water in car meaning it is a coolant), HA, flushed, tachycardia ‣#1 nursing dx: FVD ‣#1 tx: IVF ∙Outcomes: ↑UO, moist mucous membranes, etc.

Answer 137

1.DKA 2. HHNK/HHS 3. DKA ∙DKA comes in a lot later due to worsening symptoms that occur only late in diseaes ∙HHNK is treated but in bad shape ∙Die first w/o treatment:DKA

Answer 138

‣due to poor tissue perfusion and peripheral neuropathy ‣Renal failure, Impotence, Incontinece, Cant feel when they injure themselves, Can't heal properly when they injure themselves, Retinal neuropathy

Answer 139

HbA1/glycosylated Hgb ‣ in control: 6 and lower ‣out of control: 8 and abobe ‣at risk: 7, need evaluation, work up, infection somewhere

Answer 140

‣Anti-mania drug (not for depression) ‣used for BPD ‣Therapeutic level: 0.6-1.2 ‣Toxic level: >2.0 ‣grey area:1.2-2.0 (no books agree to what is going on with lithium at this area)

Answer 141

‣Treats AFIB and CHF ‣"DIG"=AFIB→abcD ‣Therapeutic level: 1.0-2.0 ‣ Toxic level: >2.0 ‣if test gives you 2.0, you answer it is toxic rather than therapeutic (to be safe)

Answer 142

‣airway antispasmodic ‣technically not a bronchodilator→it does not stimulate the B2 agonists to bronchodilate, it just relaxes a spasm ‣Therapeutic level: 10-20 ‣Toxic level: >20

Answer 143

‣use for seizures ‣Therapeutic level:10-20 ‣ toxic level: >20

Answer 144

‣Not a drug; byproduct of breakdown of RBCs ‣only tested in NBs on NCLEX (have high bilirubing bc breaking down moms RBCs) ‣Therapeutic level: Elevated level: 10-20, 9.9 and less is normal for NB ‣Toxic level: >20

Answer 145

usually about 14-15 where doctors start to hospitalize them ‣10-13 can be managed with sunlight

Answer 146

‣KERNICTERUS: Bilirubin in the brain which usually occurs when level is around 20 bc it causes ASEPTIC MENINGITIS and ASEPTIC ENCEPHALITIS due to irritation of bilirubin ‣JAUNDICE: yellow color due to bilrubin in the skin ‣OPISTHOTONOS: Position the baby has when they have kernicterus →HYPEREXTENDED ‣PHYSIOLOGIC JAUNDICE: Bilirubin is abnormal at birth, over the next 2-3 days, goes high on bilirubin ‣PATHOLOGIC JAUNDICE: Bilirubin is high at birth, yellow at birth Therfore, if they come out yellow, something is wrong. IF they turn yellow, its NORMAL

Answer 147

put them on their side

Answer 148

‣regurgitation of acid into the esophous bc the upper part of stoamch herniates upward through the diaphragm ∙gastric contents move in wrong direction, stomach empties at a normal rate, GOING THE WRONG WAY ON A ONE WAY STREET S/S: ‣GERD: Heartburn and indigestion (you can have this for many reasons) ‣Hiatal hernia is GERD if you lie down after you eat ‣If you have indigestion and heartburn, doent mean you have hiatal hernia TX: ‣ you want to stomach to empty faster bc if its empty, it wont reflux ‣"In HIGH-atal hernia, evrything needs to be HIGH" 1. High position-gravity empties stomach faster 2. Liquid meal will go though the stomach faster (so increased liquids) 3.High carbs; Low protein

Answer 149

‣Usually follows gastric surgery in which the gastric contents dump to quickly into the duodenum. ∙ gastric contents move in the right direction ∙ stomach empties at the wrong rate (increased) ∙YOURE SPEEDING S/S ‣ easiest way to remember is to take what you already know and combine it to equal dumping syndrome. ‣DRUNK+SHOCK ‣DRUNK: staggering gait, slurred speech, impaired judgment, delayed reaction time, labile emotions, decreased cerebral perfusion ‣SHOCK: hypotension, tachycardia, tachypnea, pale, cold, clammy, skin ‣DRUNK+SHOCK→HYPOGLYCEMIA ‣ABDOMINAL DISTRESS: cramping, pain, guarding, borborygmi, tenderness, diarrhea, bloating, distention TX: "WHEN EVERYTHING IS LOW, THE STOMACH EMPTIES SLOW" ‣ you want the stomach to empty slower 1.Low position--head flat→ they should eat supine, turn to the side, and eat on the side with head down 2. Low liquids: get fluids bw meals (1 or 2 hrs before or after meals) 3. Low carb content, High protein

Answer 150

‣3.5-5.1 ‣ do the SAME AS the prefix except doe HR and urine output ‣Prefix meaning HYPO or HYPER ‣HYPERkalemia = low UO, low HR ‣HYPOkalemia =high UO, High HR

Answer 151

‣8.4-10.6 ‣do the OPPOSITE of the prefix ‣HYPERcalcemia = everything goes down (↓) ‣HYPOcalcemia = everything goes UP (↑) ∙CHvostek's sign = Cheek→ you touch their cheek →spasm which is a sign of neuromuscular irritability associated w/ low calcium ∙Trousseau's sign = spasm of hand when you put BP cuff on it

Answer 152

‣1.3-2.1 ‣Magnesemias do the OPPOSITE of the prefix ‣HYPERmagnesmia= everything goes down (↓) ‣HYPOmagnemia = everything goes UP (↑)

Answer 153

1. Probably not magnesium bc its not a major player 2. If it is a skeletal muscle nerve →blame it on calcium 3. For everything else→blame it on potassium

Answer 154

a. YES b. NO c. possibility d. possibility Thought Process: This symptom is UP 1. Rule out Mg 2. Not a skeletal muscle or nerve 3. Blame it on potassium → A

Answer 155

a. possible b. NO c. YES d. possible Thought process: This symptom is UP ‣rule out Mg ‣ it is a skeletal muscle or nerve ‣ Blame it on Ca→ C

Answer 156

a. YES b. NO c. NO d. possibility Thought Process: This symptom is UP -rule out HYPERcalcemia bc it is the opposite -dont just think Ca=muscle nerves -dont just think K+=heart -Therefore, it is a tie breaker bw Mg and K→ Pick K+ →A

Answer 157

‣135-145 ‣ HypErnatrema= dEhydration ‣HypOnatremia = Overload

Answer 158

1. Hyponatremia bc of fluid overload 2. Hyponatremia 3. Hypernatremia 4. Hypernatremia 5. Hypernatremia bc patient is dehydrated 6. Fluid volume excess 7. Dehydration → Hypernatremia 8. Dehydration → Hypernatremia

Answer 159

‣ Paresthesia = Numbness and tingling ‣Circumoral paresthesia= numbness and tingling of the lips

Answer 160

Paresis: Muscle weakness

Answer 161

‣ Never push potassium IV ‣Not more than 40 of K per liter of IV fluid (if need more, call MD and clarify)

Answer 162

‣it stops your heart → cardiac arrest ‣worst electrolyte imbalance

Answer 163

‣Give D5W with regular insulin a. fastest way to lower K b. It is the K in the blood that will kill you, not the K in the cells. c. D5W doesn't get rid of extra K, it just shifts it into the cells d. Doesn't solve the problem e. will leak back into the blood after a couple of hours g. Upside: Fast and Quick h. Downside: Temporary ‣Kayexealate a. enama or oral b. full of NA c. releases Na into your blood d. to maintain negative equilibrium → K is kicked out of the blood into the gut e. trade Na for K f. Dececate K g. Blood starts out hyperkalemic and ends ups w/ hypernatremia → DEHYDRATION h. Upside: get rid of the excess K out of the body → doesn't reoccur i. DOWNSIDE → it takes a long time!! Hours, and you may not live that long

Answer 164

1.Kay 2.Exit 4.Late

Answer 165

‣ D5W with regular insulin ‣Give D5W and regular insulin + Kayexelate Simultaneously

Answer 166

thyroids and adrenals ‣ turn "THYROIDISM" into "Metabolism" →hyperMETABOLISM

Answer 167

Grave's Disease → youre going to run yourself into the grave

Answer 168

S/S: ‣weight loss ‣HTN ‣irritable ‣Heat intolerance ‣Cold tolerance ‣Exopthalamos (bulging eyes) ‣ Tachycardia

Answer 169

1. RADIOACTIVE IODINE ‣ Pt should be by themselves for 24 hours (private room) ‣ After that, they have to be very careful w/ urine → flush 3 times; if they spill urine on the ground → call hazardous team NOT housekeeping 2.PTU (propyl thyo uracil) ‣ "PUTS THYROID UNDER" ‣Must bring down thyroid hormones ‣Primary use is for cancer but one of its special uses is for thyroids ‣ Primary use is for cancer but one of its special uses is for thyroids ‣ Watch WBC due to immunosuppression 3. SURGICAL REMOVAL →THYROIDECTOMY (remove part or all of thyroid) ‣ pay attention to if it is a total or subtotal thyroidectomy; if you tx all the same, you will get it wrong 4. TOTAL THYROIDECTOMY ‣ Life long hormone replacement ‣you are risk for HYPOCALCEMIA bc its almost impossible to spare the parathyroid gland → Low PTH= low Ca ‣S/S→Ca does opposite of prefix 6. PARTIAL THYROIDECTOMY ‣may be on hormones for a bit but not life long ‣No hypocalcemia w/ this; however they're at risk for i. THYROID STORM or THYROTOXICOSIS →MEDICAL EMERGENCY →BRAIN DAMAGE → PERMANENT (total thyroidectomies never at risk for this) S/S: ‣ Super high temp (>105) ‣Extremely High BP → stroke category → 210/180 (ex) ‣Severe taychardia → 180s-200 ‣Psychotically delirious

Answer 170

‣Get temperature DOWN i.FIRST: Ice packs ii.BEST: Cooling blanket ‣Get O2 up i.O2 per mask @ 10 mL ‣OXYGEN FIRST THEM TEMPERATURE but always pick STAY WITH PATIENT i. they will come out of it themselves or they will die ii. you do not want to medicate (i.e Tylenol won't work bc hypothalamus isn't working) iii. selg limiting condition; all we do is SPARE THE BRAIN until they come out of it iv. 2 staff for ONE patient (2:1)

Answer 171

In the first 12 hours.... 1. Airway ∙edema press on the airway 2. Hemorrhage ∙Endocrine gland has lots of BV After 12 hours..... 1. Post op risks 12-48 hours after a TOTAL→ TETANY due to HYPOcalcemia 2. Post op risks 12-48 hours after a SUBTOTAL → STORM After 48 hours... 1. Biggest risk is INFECTION ∙Never pick infection before 72 hours WITH anything!!!!

Answer 172

"Hypo Metabolism" S/S: ‣flat, boring, dull ‣cold intolerance ‣heat tolerance ‣bradycardia ‣slow processing ‣bradypnea Tx: 1. not enough hormone, sog gibe them thyroid hormones (synthroid/levothyroxine) 2. Do not sedate these people bc theyre already super slow →coma ‣ always question NPO before sx bc thhen they cant take their meds!!! If they dont have hormones --> anasthetic can kill thm ‣ NEVER HOLD SYNTHROID w/o expressed orders to do so

Answer 173

Adrenal Cortex i.e. Addison's disease, Cushings syndrome

Answer 174

Under secretion of adrenal cortex S/S ‣Hyperpigmented (very tanned, look healthy) ‣Do not adapt to stress ∙when you are under stress, there's a threat to your brain ∙purpose of stress response→ raise glucose and raise BP ∙THEREFORE, hypoglycemia and hypotension →shock TX: Steroids (end in -sone) "ADDISON'S YOU ADD A SONE'

Answer 175

over secretion of adrenal cortex " anything that is cushy means you have more" s/s 1. Moon face 2. Acne 3. Hirsutism 4. retaining water 5. Gynecomastia 6. Increased Bruising 7. Muscle atrophy 8. Central Obesity 9. Losing K 10. Osteoporosis 11. Striae 12. Increased Glucose→Need accuchecks even if not diabetic 13. Irritable TREATMENT: 1. You have too much →you need to cut it out →Adrenalectomy ‣Bilateral adrenalectomy→ can induce Addison's disease ∙then you have to take corticosteroids ∙then you end up looking like Cushman again ∙Takes a year or 2 to get back to normal

Answer 176

1. is it safe? 2. is it age appropriate? 3. is it feasible

Answer 177

1. No small toys under age 4→RF aspiration 2. No metal toys if oxygen is in use →RF sparks 3. Fancy words to use→ DIE-CAST 4. Beware of fomites (non living object that harbors micro organisms) ∙worst fomites: stuffed animals ∙best toys: hard plastic (can be disinfected)

Answer 178

Musical Mobile ‣these kids are sensory-motors ‣if boards don't have this, second best answer is something SOFT, but it has to be large due to RF aspiration

Answer 179

‣Cover-uncover toy (i.e.. jack in box, pop up pals, books that have little windows, peek a boo, cover yourself under the blanket) ‣ working on object permanence (its still there even though you can't see it) ‣Second best toy: Something LARGE, but firm (wood, metal, hard plastic) ‣Worst toy: musical mobile (they pull themselves up and strangulation occurs)

Answer 180

‣speaking toys, talking toys, verbal toys (i.e. tickle me elmo, talking anything) ‣ working on vocalization ‣purposeful activity starts here

Answer 181

1.YES 2.NO "Build" is a purpose word

Answer 182

Build, Sort, Stack, Make, Construct a baby is in the womb for 9 months and its another 9 months until they can do something purposeful

Answer 183

Best toy: push or pull toy (lawn mower, wagon, buggy, baby strollers) ‣if it takes finger dexterity → not for toddler (i.e. colored pencils, scissors, etc.) ‣finger painting is okay ‣parallel play→ play alongside but not with others

Answer 184

‣work on fine motor ‣finger dexterity ‣work on balance ‣ex: tricycyles, dance class, ice skates, etc. ‣cooperative play → play together and interact ‣they like to pretend → highly imaginatve

Answer 185

1. Creative: let them make it. Don't give it to them ‣don't give them a coloring book with pencils, give blank paper and pencils to create their own pictures ‣i.e. Legos 2. Collective: always collecting something 3. Competitive: They like to play games where there's a winner or a loser

Answer 186

‣peer group association ‣let teenagers hang together UNLESS: ∙if anyone is fresh post-op (<12 hours out of surgery) ∙if anyone is immunosuppressed ∙if anyone has a contagious disease

Answer 187

‣Lamina: vertebral spinus processes why?: to remove nerve root compression bc sometimes when they come out of the spinal cord, there's calcium or herniated disks or inflammatory masses pressing on them → cut away the bone →give nerve more room to exit → relieve compression of nerve root S/S of nerve root compression 1. Pain 2. Paresthesia (numbness and tingling) 3. Paresis (muscle weakness)

Answer 188

1. Cervical → Neck 2. Thoracic → upper back 3. Lumbar → lower back

Answer 189

cervical innervates → diaphragm and arms Therefore, assessment of: 1. breathing 2. Back up answer → function of arms and hands (back up answer)

Answer 190

thoracic innervates → abdominal muscles and gut muscles Therefore, assessment of: 1. How patient coughs ∙put hand on abdomen, cover your mouth, and on my signal cough. You should feel a contraction → you CAN cough ∙With a thoracic spinal cord injury, you can no longer contract your abdomen. You are paralyzed → You CANNOT cough. You can breathe 2. Back up answer → Bowel Sounds

Answer 191

Lumbar innervates → bladder and legs Therefore, assessment of: 1. Last time of void ∙is it empty or full? 2. Back up answer → function of legs

Answer 192

#1 answer → LOG ROLL 1.Mobilizing Patients after Laminectomy ‣ Do not dangle (no sitting at side of bed) ‣ Go from lying down immediately to walking around (only exception is for orthostatic hypotension) ‣Do not sit longer than 30 min ‣ They may walk, stand, lie down WITHOUT restrictions (restrictions only with sitting)

Answer 193

Up in chair for 2 hours TID

Answer 194

unit clerk bc they sit all day

Answer 195

Cervical: They won't breathe deeply after surgery → Pneumonia Thoracic: they won't cough so well →Pneumonia and Ileus Lumbar: urinary retention followed by problems with legs

Answer 196

d. urinary retention bc its lumbar, all you need to know is the location, you don't need to necessarily know what it is

Answer 197

chest tubes -from the front, you go through the chest, to the spine ∙can lead to pneumohemothorax (which requires CT)

Answer 198

∙takes a bone graft from the iliac crest ‣if you take the dic out you cannot have bone on bone ‣ you take bone from hip, and put in bw to fuse it so there's no grinding, therefore they will have 2 incisions (one on hip and one on spine)

Answer 199

TEMPORARY: 1. do not sit for longer than 30 minutes which applies for 6 weeks 2. Lie flat and log roll for 6 weeks 3. No driving for 6 weeks 4. Do not lift more than 5 pounds for 6 weeks (a gallon of milk is about 5 lbs) PERMANENT: 1. Do not pick ups objects by bending at the waist; bend with the knees! 2. Cervical laminectomies are not allowed to lift anything OVER THEIR HEAD (need a step stool) 3. No jerky car rides, bike rides, roller coasters, etc

Answer 200

A.)Low Priority: Yes it's abnormal, may be presence of disease, but no big deal. For instance, you could wait all night then have it assessed tomorrow, it's okay. B.) Still a Low Priority: It is abnormal, you need to be concerned, you just need to watch them closer. C.) High Priority: It is critical; you must do something about it. D.) Highest Priority: can be deadly

Answer 201

0.6-1.2 Low priority: phone call worthy only if they were going for a test that had a dye in it

Answer 202

-monitors warfarin (Coumadin) therapy -variation of prothrombin time 2's to 3'a High Priority: 4 and above ‣ What do you do? ∙Follow an order ∙First thing you do is HOLD ∙After you hold, then you assess but a FOCUSED ax based on which body part ∙Prepare to give the drug ∙Call physician/RT/etc.

Answer 203

LOW K is High Priority ‣Don't HOLD ‣Assess heart ‣Prepare to administer K+ ‣Call MD Bw 5.4-5.9 is High Priority ‣HOLD all K+ ‣Ax the heart ‣Prepare to give kayexalate and D5W and regular insulin ‣Call MD 6 and greater is the Highest Priority ‣Deadly dangerous ‣Same protocol but more staff on hands ‣Don't leave your pt and do what you can do at the bedside

Answer 204

pH in 6's is the Highest Priority ‣Ax vitals bc pH is going down! ‣Only way to correct is to tx the underlying cause ‣Low pH get the physician on the case!!!! ‣Stay with the patient

Answer 205

8-25 How many buns do you but in a pack--8! <8 is a low priority→ ax for dehydration

Answer 206

12-18 ‣ 8-11 is still a low priority →ax for low Hgb → bleeding or malnutrition (anemia) ‣ If <8, its a High Priority → do something!! ∙ax for bleeding, prepare to administer blood, Call MD

Answer 207

22-26 abnormal bicarb is a Low priority

Answer 208

35-45 ‣ A CO2 that high but in 50s → High Priority ∙its critical ∙Not COPDers, just normal pts ∙ax respiratory status ∙pursed lip breathing ∙call MD ‣A CO2 that's in the 60s→Highest Priority ∙do not leave the room ∙prepare to intubate and ventilate ∙call RT and then call MD

Answer 209

36-54 (its the Hgb x3) ‣elevated Hct is still a low priority ‣ax dehydration

Answer 210

78-100 1.)If it is low, but still in 70's (70-77), its a HIGH priority ∙Prepare to administer O2 ‣When hypoxic, the heart will increase FIRST then respirations will ‣2 common causes for episodic tachycardia: -hypoxia -dehydration 2.)If in 60's, its the HIGHEST priority ∙both CO2 and O2 in 60s → intubate and ventilate ‣Throw on O2 to make comfortable ‣Ax pt ‣Prepare to intubate or ventilate ‣Stay with patient ‣Call MD

Answer 211

93-100 ‣Anything less than 93 is a High Priority ∙Ax resp ∙Prepare O2 ‣In pediatrics→95% is a HIGH priority ‣COPDers run high on CO2 and low on O2 ‣Anemia falsely elevates SaO2; therefore look for other ways to ax oxygenation ‣dye in last 48 hours also falsely elevates and invalidates O2 because dye colours the blood

Answer 212

best indicator of CHF <100 100 is still a low priority →CHF but you’re not gonna die; it’s a chronic condition

Answer 213

135-145 ‣Abn is still a low priority ‣ If high, ax for dehydration ‣ If low ax for overload ‣ If question says Na is abn and change in LOC it is a HIGH priority→ safety issue

Answer 214

‣Total WBC: 5,000 – 11,000 ‣Absolute Neutrophil Count (ANC): 500 ‣CD4 count: 200 (when <200 → AIDs!) All abnormal values are HIGH priority ‣Ax for signs of infection Place them on neutropenic precautions: ∙ Follow strict hand washing ∙ Shower BID with antimicrobial soap ∙ Avoid crowds ∙ Private room ∙ No fresh flowers or potted plants ∙ Low bacteria diet- no raw fruits/veggies, no undercooked meat. No water drinking if its been sitting for longer then 15 minutes. ∙Vitals Q4H ∙ Check WBC daily ∙ Avoid reusable plates/silverware etc,

Answer 215

Thrombocytopenic <90,000 ∙Thrombocytopenic is a HIGH priority→bleeding precautions ∙If < 40,000→Highest Priority Prepare transfusion and call doctor

Answer 216

4-6 million Abnormal is still a low priority

Answer 217

‣If they give you an elevated blood value, you have no idea, dehydration is a good guess because when you’re dehydrated, your blood cells are inc = dehydration. - Ax before you do unless delaying what you do before you ax would put your patient at higher risk. - Delaying stopping the blood to do an ax → inc risk; therefore you do before you assess - Position first if there’s TWO DO’S - But what if it’s a FIRST question versus BEST question? ‣ BEST=O2 ‣ FIRST=RaiseHOB

Answer 218

1. pH in the 6’s 2. Potassium in the 6’s 3. CO2 in the 60’s 4. PO2 in the 60’s 5. Platelets <40,000

Answer 219

1. Take first day of the last menstrual period 2. Add 7 days 3. Subtract 3 months

Answer 220

‣Total weight gain: 28 lbs +/- 3. ‣ In the first trimester (1-12), she gains 1 pound, each month. First trimester is 3 months She gains a total of 3 pounds in 3 months ‣ In the second (13-27) and third trimester (28-40), she is gaining much faster. She gains 1 pound, per week.

Answer 221

Rule: Difference of 9→ Week -9= ideal lbs gained ‣if within 1-2 lbs=okay ‣3 lbs off = ax ‣4 lbs off = trouble

Answer 222

‣Fundus: Top part of the uterus. Not palpable until week 12. ‣Therefore, in 1st trimester you CANNOT palpate the fundus. ---What if she’s gained 10 lbs in trimester, and fundus is WAY up high?: she’s either not in the 1st trimester or she has hypermolar pregnancy (Cancerous). ‣You can palpate the fundus after the END of the 1st trimester.

Answer 223

20 – 22 weeks of gestation. important to know bc You can use fundal height to ax the age of gestation. For instance, mom comes in ER after MVC. She is unable to tell you how far along she is.

Answer 224

‣Non palpable = 1st trimester. Mom is the priority. ‣At or below the belly button = 2nd trimester. Mom is the priority. ‣Above the belly button = 3rd trimester. Baby is the priority.

Answer 225

1. Fetal skeleton on XRAY 2. A fetal presence on U/S 3. Auscultation of fetal HR (8 – 12 weeks is when you can hear it although it starts beating at 5 weeks) 4. When the examiner palpates fetal movement NOT the mom

Answer 226

1. 8 wks 2. 10 wks 3. 12 wks

Answer 227

1. All urine and blood pregnancy tests - A positive pregnancy test is NOT a positive sign of pregnancy = TRUE, because it means you have the hormonal increases but you may not have a fetus→false positive pregnancy test 2. Chadwick’s, Goodell’s, Heger’s a.) Chadwick’s sign →cervical colour change to cyanosis If the cervix is doing it, the vagina is too. b.)Goodell’s sign → cervix softening c.) Hegar’s sign → uterine softening d.) They occur in alphabetical order!!! e.) Boards tests more on the order not necessarily what week

Answer 228

Good prenatal care→How often to come in for good prenatal care a. Once a month until week 28 (1st trimester, 2nd trimester, up until 7th month) b. AT week 28, once every two weeks until week 36 c. Then, every week until delivery OR week 42 i. At week 42 → C-section or induction

Answer 229

1. HGB WILL FALL ‣ Normal: 12-16 ‣1st trimester: 11 and it is normal. ‣ 2nd trimester: 10.5 and still normal. ‣ 3rd trimester: 10 and still normal. DISCOMFORTS OF PREGANCY ‣MORNING SICKNESS i. 1st trimester ii. Tx: Dry carbohydrates before she gets out of bed ‣ URINARY INCONTINENCE i. 1st and 3rd trimester ii. 2nd trimester → no incontinence because it’s not on bladder it’s in abdomen iii. Tx: Void q2hrs all the way from the day she gest pregnant until 6 weeks after delivery ‣DIFFICULTY BREATHING i. 2nd and 3rd trimester ii. Tx: Tripod position →Feet flat, arms on table, leaning forward ‣ BACK PAIN i. 2nd and 3rd trimester ii. Tx: Pelvic tilt exercisesàtilt the pelvis forward THAT’S IT FOR PREGNANCY BECAUSE THE REST SHOULD BE COMMON SENSE À WHEN YOU GET A QUESTION YOU DON’T KNOW THE ANSWER TO À PICK THE ANSWER THAT YOU WOULD PICK FOR SOMEONE ELSE. PREGNANCY IS NOT A DISEASE!

Answer 230

DILATION: ‣Opening of cervix. It goes from 0-10cm. A cervix that is 0 = closed. A cervix that is 10 = fully dilated. EFFACEMENT: ‣ thinning of the cervix. It goes from THICK to 100%. A cervix that is not effaced is described as thick. A completely effaced cervix is 100%. STATION: Relationship of fetal presenting part to mom’s ischial spines. 1.)ISCHIAL SPINES: smallest diameter that the baby has to pass through in ordert obe birthed vaginally. If it cannot fit through there, it cannot be birthed vaginally. 2.)NEGATIVE STATION: Presenting part is ABOVE ischial spines. 3.)POSITIVE STATION: Presenting part is BELOW ischial spines. ‣ Way to remember stations: “Positive numbers are positive news. Negative numbers are negative news.” ENGAGEMENT: Station 0. Presenting part is AT the ischial spines. LIE: Relationship between spine of mother and spine of baby. 1.)VERTICAL LIE:Compatible with vaginal birth, uncomplicated. ‣Mom’s spine and baby’s spine are parallel = GOOD = BABY 2.) TRANSVERSE LIE: Baby’s spine is perpendicular to mom’s spine, complicated, trouble. ‣T which is transverse = BAD = TROUBLE PRESENTATION: Part of baby that enters the birth canal first. Wonderful little alphabet soups. ‣Nobody really knows the presentations (it’s not an average question) ‣Most common: ROA so just pick that one! Or LOA.

Answer 231

1.Labour – Composed of THREE phases. a.) LATENT: First three letters are “LAT” which are the initials of the phases in order! b.)ACTIVE c.) TRANSITION 2. Delivery of baby 3. Delivery of placenta 4. Recovery a.) recovery lasts for 2 hours.

Answer 232

1.) To dilate and efface the cervix. 2.) To push the baby out. 3.) To push the placenta out. 4.) To contract the uterus to stop bleeding. 5.) Two hours after the placenta is delivered. 6.) Pain management 7.) Airway of baby 8.) Checking dilation, helping with pain, helping with breathing. 9.) Making sure there’s three vessels in the cord. DONT GET MIXED BW STAGES AND PHASES

Answer 233

- It is a mix of insulins, R and N. - 70 and 30 are percentages - 70% is NPH - 30% is Regular Note: How do you remember that 70 is N? 7030 is like a fraction. The top number is called a Numerator which starts with N and so does Insulin NPH. Examples: - If you gave 100U of 7030 → there would be 70U of NPH and 30U of Regular - If you gave 50U of 7030 → there would be 35U of NPH and 15U of Regular

Answer 234

yes. How? ‣You want to be an RN right? Then do it in that order. Regular then NPH. Clear then cloudy. Pressurizing the vile? ‣Inject the air into the N first then inject the air into the R. Then draw up the R then draw up the N.

Answer 235

ROUTE: ∙ IV or SC ONSET: ∙works immediately HOW LONG CAN USE? ∙Cannot be given for longer than 3 weeks (except for Lovanox) because in 21 days you start to make heparin antibodies ANTIDOTE: ∙Protamine Sulfate “heParin → Protamine” LAB TESTS: ∙PTT Heparin = 7 fingers 3 fingers left = PTT PREGNANCY: ∙Can be given to pregnant women

Answer 236

ROUTE: ∙PO only ONSET: ∙works immediately HOW LONG CAN USE? ∙Can be given for the rest of your life ANTIDOTE: ∙Vitamin K “Koumadin” LAB TESTS: ∙PT which is what the INR is derived from "Coumadin = 8 fingers 2 fingers left = PT" PREGNANCY: ∙Cannot be given to pregnant women

Answer 237

‣ If it ends in X or + DIURIL →X’s OUT K →it is POTASSIUM WASTING ‣ If it does not end in x and is not a diuril→it is POTASSIUM SPARING "-semides are typically X's

Answer 238

muscle relaxants Side Effects: 1. Drowiness/Fatigue 2. Muscle weakness Teachings: 1. Don’t drink 2. Don’t drive 3. Don’t operate heavy machinery “Baclofen: If I’m on my back loafin, I’m on my baclofen” IT’S A MUSCLE RELAXANT.

Answer 239

* How do you know a woman is in trouble. For instance, they will give you four women and ask, who is in trouble? * How do you know a woman is in uterine tetany? * How will you know a woman is in uterine hyperstimulation? * What parameters would make you stop ptosin?

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